GOP Promise To Repeal Obamacare Worries Physicians And Hospitals

Republicans have promised to repeal and replace the Affordable Care Act pretty much since the law’s enactment in 2010. (Jan. 12, 2017)

Hospital executives, doctors and tens of thousands of Connecticut residents who receive health insurance through the Affordable Care Act are growing alarmed at the speed of the Republican drive to dismantle the landmark legislation without first enacting a replacement.

"It's causing a lot of angst among patients and physicians," said Jeffrey Gordon, a hematologist-oncologist from Waterford and president of the Connecticut State Medical Society. His group, which represents more than 7,000 Connecticut doctors, is watching the debate in Washington closely.

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"We have people come and see us for care. What will they have if the Affordable Care Act is repealed and not replaced? We can't just suddenly say no," Gordon said.

Early Thursday, the Senate voted narrowly to approve a budget resolution that directs congressional committees to start work on legislation that would gut the Affordable Care Act. The House is likely to vote on Friday. While the votes are essentially procedural, they clear the way for repeal of President Obama's signature initiative.

Leaders of the Connecticut Hospital Association joined colleagues from similar groups across the nation in Washington this week to discuss the looming overhaul of health care policy in the U.S.

"Connecticut hospitals are deeply concerned about how patients would be affected if the Affordable Care Act is repealed,'' the association said in a statement. "Repealing the ACA leaves open questions about how health care will be delivered and funded ... repealing the ACA without a replacement causes great concern."

Hospital officials are pressing for the restoration of billions in Medicare funds, should the health care law be scrapped. "The ACA expanded coverage to a significant number of individuals; this expansion was funded in part through cuts to Medicare payments to hospitals. If the law is repealed and the cuts to Medicare remain in place, Connecticut hospitals' fiscal stability and sustainability, as well as patient access to care, will be significantly compromised," the association said.

The group projected that Connecticut hospitals would lose approximately $5.4 billion in Medicare funding over 10 years as a direct result of the ACA being repealed.

"I don't understand what the rush is," said Sen. Chris Murphy, a Connecticut Democrat and one of the health care law's fiercest defenders. "Why do this kind of damage to people and repeal the health care law right now? I'll keep making that case and continue fighting this repeal every single step of the way."

The undoing of the law that has enabled 20 million Americans to obtain health insurance could come within months. On Wednesday, President-elect Donald Trump said repeal would occur "essentially simultaneously" with replacement. He provided no specifics of what his health care plan would look like but promised to unveil it once his nominee for Secretary of Health and Human Services, Tom Price, is confirmed. Some moderate House Republicans have pressed for delaying a repeal vote until a replacement is ready.

Gov. Dannel P. Malloy, a Democrat, drew some encouragement from signals that repeal would coincide with replacement. "Cooler heads are prevailing," he said. "There are enough wise people saying you can't do this. You can't destroy a system which is working, albeit not perfectly, and replace it with no system.''

Malloy was especially critical of House Speaker Paul Ryan's fast-track approach, which he characterized as "let's gut the whole thing and watch it bleed to death on the floor."

While physicians have different views on the merits of Obamacare, most agree that the complex law should not be eviscerated until a substitute is found, said Gordon of the state medical society. "A lot of provisions need to be fixed but we're very concerned about wholesale repeal, especially if no one knows what's going to replace it," he said.

The insurance industry, meanwhile, has kept a low public profile during the increasingly intense debate in Washington.

"It's not clear what repeal/replace/delay will look like," said Mark Slitt, spokesman for Cigna. "Any discussion would be purely speculative."

Certain elements of Obamacare remain popular, including a provision that permits children under 26 to remain on their parents' policies. But even the law's most ardent defenders acknowledge its shortcomings.

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Repealing the Affordable Care Act has been at the top of Republicans' to-do list since the law was signed by Obama in 2010. "This was their number one on their campaign agenda," said U.S. Rep. John Larson, a Democrat who represents the 1st District. "If they have a better plan that covers all the things that the Affordable Care Act does, then that's something we've got to look at."

Under the act, the number of uninsured people in Connecticut has dipped from 8 percent in 2011 to 3 percent. About 110,000 residents have obtained insurance coverage through the state's health care exchange. Additionally, more than 200,000 residents are now covered under the expansion of Medicaid made possible under the law.

"There are certainly flaws in the Affordable Care Act but partisan squabbling never allowed for the ability to repair a less-than-perfect bill," said Dr. Rocco Orlando, senior vice president and chief medical officer for the Hartford HealthCare system, which operates five acute care hospitals, two behavioral health hospitals and a myriad of outpatient programs across the region.

"I become concerned anytime there is a rush to do something this complicated this quickly," Orlando said. "We just run the risk of getting something wrong."